Provider Demographics
NPI:1861015513
Name:FLORIDA MENTAL HEALTH RESOURCES, LLC
Entity Type:Organization
Organization Name:FLORIDA MENTAL HEALTH RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:PILAR
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:305-882-9144
Mailing Address - Street 1:9044 NW 174TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6680
Mailing Address - Country:US
Mailing Address - Phone:305-882-9144
Mailing Address - Fax:305-328-4545
Practice Address - Street 1:11093 NW 138TH ST UNIT 121
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-1191
Practice Address - Country:US
Practice Address - Phone:305-882-9144
Practice Address - Fax:305-328-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110127800Medicaid